Barotrauma in Mechanical Ventilation: Causes and Management

Barotrauma is a serious complication in respiratory care that occurs when excessive pressure within the lungs leads to tissue injury and air leakage. It is most commonly associated with mechanical ventilation, particularly when positive-pressure ventilation is used improperly or when lung compliance is reduced.

Understanding barotrauma is essential for respiratory therapists and clinicians because it directly impacts patient safety and outcomes.

By recognizing its causes, pathophysiology, and early signs, healthcare providers can implement strategies to minimize risk and ensure effective ventilatory support.

What Is Barotrauma?

Barotrauma refers to lung injury caused by elevated pressure within the alveoli and airways. In clinical practice, it is most often seen in patients receiving mechanical ventilation, where external pressure is applied to inflate the lungs. When this pressure exceeds the normal tolerance of lung tissue, it can result in overdistention and rupture of alveoli.

This condition is not limited to one specific disease process. Instead, it represents a mechanical injury that occurs when the balance between delivered pressure and lung compliance is disrupted. The result is damage to delicate alveolar structures and the escape of air into surrounding tissues.

Barotrauma is frequently discussed as part of ventilator-induced lung injury (VILI), which includes several overlapping mechanisms such as volutrauma, atelectrauma, and biotrauma. While these processes differ in cause, they often occur together and contribute to worsening lung damage in critically ill patients.

Relationship to Mechanical Ventilation

Mechanical ventilation plays a central role in the development of barotrauma. This form of respiratory support delivers air into the lungs using positive pressure rather than the negative pressure generated during normal breathing. While lifesaving, this approach introduces the risk of excessive pressure exposure.

Two primary ventilator modes influence how pressure is delivered:

Volume-Controlled Ventilation

In volume-controlled ventilation, a preset tidal volume is delivered with each breath regardless of the pressure required. If lung compliance is reduced, as seen in conditions like acute respiratory distress syndrome (ARDS), higher pressures may be needed to deliver the set volume. This can result in elevated airway pressures and increased risk of alveolar injury.

Pressure-Controlled Ventilation

In pressure-controlled ventilation, the clinician sets a maximum airway pressure, and the delivered volume varies depending on lung compliance. This approach limits peak pressure and can reduce the risk of overdistention. For this reason, pressure-controlled modes are often considered more protective in patients at risk for barotrauma.

Key Ventilator Variables

Several ventilator settings directly influence the likelihood of barotrauma:

• Tidal volume
• Peak inspiratory pressure (PIP)
• Plateau pressure
• Positive end-expiratory pressure (PEEP)

Note: Careful adjustment of these variables is essential to prevent excessive pressure within the lungs.

Pathophysiology of Barotrauma

The development of barotrauma follows a clear sequence of events related to excessive pressure exposure.

Alveolar Overdistention

When high pressures are applied during ventilation, alveoli begin to stretch beyond their normal elastic limits. Healthy alveoli are capable of expanding and recoiling, but excessive pressure disrupts this balance.

Alveolar Rupture

If the pressure continues to increase, the alveolar walls may rupture. This represents the critical point at which barotrauma occurs. The integrity of the alveolar membrane is compromised, allowing air to escape.

Air Leakage

Once rupture occurs, air can travel along tissue planes and enter spaces where it is not normally present. The direction of air movement determines the specific clinical manifestation.

Factors That Influence Injury

The severity of barotrauma depends on several factors:

• Magnitude of applied pressure
• Duration of exposure
• Underlying lung condition
• Distribution of ventilation within the lungs

Note: Patients with heterogeneous lung disease are particularly vulnerable because some regions receive more airflow than others, increasing the risk of localized overdistention.

Types of Barotrauma

Barotrauma can present in several ways depending on where the escaped air accumulates. These conditions are often grouped as air leak syndromes.

Pneumothorax

Pneumothorax occurs when air enters the pleural space between the lung and chest wall. This leads to partial or complete lung collapse and impaired gas exchange. It is one of the most common and clinically significant manifestations of barotrauma.

Tension Pneumothorax

Tension pneumothorax is a severe form in which air continues to accumulate in the pleural space without escape. This increases intrathoracic pressure, compresses the lungs, and reduces venous return to the heart. It is a life-threatening emergency that requires immediate intervention.

Pneumomediastinum

In pneumomediastinum, air collects in the mediastinum, the central compartment of the thoracic cavity. This condition may affect surrounding structures, including the heart and major vessels.

Subcutaneous Emphysema

Subcutaneous emphysema occurs when air travels into the subcutaneous tissues beneath the skin. It is often detected by swelling and a crackling sensation during palpation.

Air Embolism

Although rare, air can enter the vascular system and lead to an air embolism. This is a serious complication that can impair blood flow and cause organ damage.

Risk Factors for Barotrauma

Several clinical factors increase the likelihood of developing barotrauma during mechanical ventilation.

• High Airway Pressures: Elevated peak inspiratory pressures and plateau pressures are major contributors. Excessive pressure directly increases the risk of alveolar overdistention and rupture.
• Large Tidal Volumes: Delivering large tidal volumes can overstretch alveoli, particularly in patients with reduced lung compliance. This contributes to both barotrauma and volutrauma.
• Excessive PEEP: Positive end-expiratory pressure is used to prevent alveolar collapse and improve oxygenation. However, excessive PEEP can lead to overinflation of already open alveoli, increasing the risk of injury.
• Reduced Lung Compliance: Conditions such as ARDS cause the lungs to become stiff and difficult to inflate. Higher pressures are required to deliver adequate ventilation, which increases the risk of barotrauma.
• Obstructive Lung Diseases: In diseases such as chronic obstructive pulmonary disease (COPD) and asthma, air trapping can occur due to prolonged exhalation times. This leads to auto-PEEP, which raises intrathoracic pressure and contributes to barotrauma.
• Inadequate Monitoring: Failure to closely monitor ventilator settings, pressures, and patient response can delay the detection of early warning signs, allowing injury to progress.

Clinical Presentation

Barotrauma often presents suddenly and may rapidly progress if not recognized.

Respiratory Signs

Patients may exhibit:

• Sudden decrease in oxygen saturation
• Increased work of breathing
• Asymmetrical chest expansion

Note: These findings suggest impaired ventilation and possible lung collapse.

Ventilator Indicators

Mechanical ventilators provide important clues, including:

• Sudden increase in peak airway pressures
• High-pressure alarms
• Decreased delivered tidal volume in pressure modes

Note: These changes may indicate worsening lung compliance or the presence of an air leak.

Physical Examination Findings

Clinicians may observe:

• Decreased or absent breath sounds on one side
• Tracheal deviation in severe cases
• Subcutaneous crepitus

Note: These signs help localize the problem and guide further evaluation.

Hemodynamic Changes

In severe cases, especially tension pneumothorax, patients may develop:

• Hypotension
• Tachycardia
• Reduced cardiac output

Note: These findings indicate compromised circulation and require immediate intervention.

Diagnosis of Barotrauma

Accurate diagnosis requires a combination of clinical assessment and diagnostic tools.

• Chest Radiography: Chest X-ray is the most commonly used imaging modality. It can identify pneumothorax, mediastinal air, and other air leak syndromes.
• Clinical Assessment: A thorough physical examination and evaluation of symptoms are essential. Sudden changes in respiratory or cardiovascular status should raise suspicion.
• Ventilator Data Analysis: Reviewing ventilator parameters helps identify abnormal pressure trends and changes in lung mechanics. This information supports clinical decision-making.
• Advanced Imaging: In some cases, computed tomography (CT) may be used to provide a more detailed view of lung structures and air distribution.

The Role of Lung Mechanics

Understanding lung mechanics is essential for preventing and managing barotrauma.

• Compliance: Lung compliance refers to the ease with which the lungs expand. Low compliance means the lungs are stiff and require higher pressures to inflate. This increases the risk of barotrauma.
• Resistance: Airway resistance affects how easily air flows through the respiratory tract. Increased resistance can contribute to higher pressures during ventilation.
• Transpulmonary Pressure: Transpulmonary pressure represents the difference between alveolar pressure and pleural pressure. Excessive transpulmonary pressure is a key factor in alveolar overdistention and injury.

Prevention of Barotrauma

Preventing barotrauma is a primary goal in the management of mechanically ventilated patients. Because this complication is largely related to ventilator settings and lung mechanics, it can often be minimized through careful planning and continuous monitoring.

Lung-Protective Ventilation

One of the most effective strategies is the use of lung-protective ventilation. This approach focuses on reducing stress and strain on the alveoli while maintaining adequate gas exchange.

Key principles include:

• Using low tidal volumes, typically around 6 mL/kg of ideal body weight
• Limiting plateau pressure to less than 30 cmH₂O
• Avoiding excessive peak inspiratory pressures

Note: These measures help prevent overdistention and reduce the likelihood of alveolar rupture.

Optimization of PEEP

Positive end-expiratory pressure plays a dual role. It helps prevent alveolar collapse and improves oxygenation, but excessive levels can increase the risk of overinflation.

Clinicians must carefully titrate PEEP to balance these effects. The goal is to maintain alveolar recruitment without causing excessive pressure in already open lung units.

Monitoring Ventilator Parameters

Continuous monitoring is essential for early detection of potential problems. Important parameters include:

• Peak inspiratory pressure
• Plateau pressure
• Tidal volume
• Lung compliance

Note: Trends in these values often provide early warning signs of worsening lung mechanics or developing complications.

Individualized Ventilator Settings

Each patient has unique lung characteristics. Ventilator settings should be adjusted based on the patient’s condition rather than using a one-size-fits-all approach.

Patients with conditions such as acute respiratory distress syndrome require special consideration because of their reduced compliance and uneven distribution of ventilation.

Management of Barotrauma

When barotrauma occurs, prompt recognition and intervention are critical to prevent further injury and complications.

Immediate Interventions

The first step is to stabilize the patient and address any life-threatening conditions.

Key actions include:

• Reducing airway pressures by adjusting ventilator settings
• Lowering tidal volume
• Decreasing PEEP if appropriate
• Switching to a more protective ventilator mode

Note: These changes help minimize further damage to the lungs.

Treatment of Pneumothorax

If a pneumothorax is present, immediate intervention is required.

• Needle decompression may be performed in emergency situations
• Chest tube placement is often necessary to remove air from the pleural space
• Continuous drainage allows the lung to re-expand

Note: In cases of tension pneumothorax, rapid intervention is essential to restore hemodynamic stability.

Ongoing Management

After initial stabilization, clinicians must continue to monitor the patient closely.

This includes:

• Frequent reassessment of ventilator settings
• Monitoring oxygenation and ventilation
• Evaluating for recurrence or progression of air leaks

Note: Adjustments should be made as the patient’s condition evolves.

Barotrauma in Special Populations

Certain patient groups are at higher risk for barotrauma and require additional consideration.

Acute Respiratory Distress Syndrome

Patients with acute respiratory distress syndrome have stiff, noncompliant lungs with uneven ventilation distribution. Some alveoli are collapsed, while others remain open.

When positive pressure is applied, air preferentially enters the more compliant regions, leading to overdistention and increased risk of injury. This makes lung-protective strategies especially important in this population.

Obstructive Lung Disease

Patients with conditions such as COPD and asthma are prone to air trapping due to prolonged exhalation times. This can result in auto-PEEP, which increases intrathoracic pressure and contributes to barotrauma. Adjustments such as increasing expiratory time and reducing respiratory rate can help mitigate this risk.

Pediatric and Neonatal Patients

Younger patients have more delicate lung structures and are particularly susceptible to injury from excessive pressure. Careful control of ventilator settings and close monitoring are essential to prevent complications in this population.

Complications and Outcomes

Barotrauma can lead to a range of complications, some of which are life-threatening.

Respiratory Complications

Air leak syndromes can impair ventilation and oxygenation. Lung collapse reduces the surface area available for gas exchange, leading to hypoxemia.

Cardiovascular Effects

In severe cases, increased intrathoracic pressure can reduce venous return to the heart. This may result in decreased cardiac output and hypotension.

Prolonged Mechanical Ventilation

Barotrauma may delay recovery and prolong the need for ventilatory support. This increases the risk of additional complications, including infection and muscle weakness.

Impact on Mortality

Severe forms of barotrauma, particularly tension pneumothorax and air embolism, are associated with increased mortality. Early recognition and treatment are critical for improving outcomes.

Role of the Respiratory Therapist

Respiratory therapists play a central role in preventing, identifying, and managing barotrauma.

Ventilator Management

Therapists are responsible for setting up and adjusting ventilator parameters based on patient needs. This requires a strong understanding of lung mechanics and ventilation strategies.

Monitoring and Assessment

Continuous monitoring allows therapists to detect early signs of deterioration. This includes evaluating:

• Breath sounds
• Chest movement
• Oxygenation
• Ventilator pressures

Note: Prompt recognition of abnormal findings is essential.

Collaboration with the Healthcare Team

Effective communication with physicians and nurses ensures coordinated care. Decisions regarding ventilator adjustments and interventions often require a team-based approach.

Patient Safety

Ultimately, the goal is to provide safe and effective respiratory support while minimizing the risk of complications. This requires vigilance, knowledge, and attention to detail.

Exam Relevance

Barotrauma is a high-yield topic for respiratory therapy students preparing for board examinations.

Common exam scenarios include:

• Sudden increase in peak airway pressure
• Rapid decline in oxygenation
• Detection of absent breath sounds on one side
• Interpretation of ventilator alarms
• Identification of appropriate emergency interventions

Note: Students must be able to quickly recognize these signs and select the correct course of action. Understanding barotrauma also reinforces broader concepts such as lung mechanics, ventilator management, and patient monitoring, all of which are essential for exam success.

Barotrauma Practice Questions

1. What is pulmonary barotrauma in mechanically ventilated patients?
Injury caused by excessive lung distending pressure that leads to alveolar rupture and air leaks.

2. What are common manifestations of pulmonary barotrauma?
Pneumothorax, pneumomediastinum, and subcutaneous emphysema.

3. What additional air-leak syndromes may occur with barotrauma?
Pneumopericardium and pneumoperitoneum.

4. Why is plateau pressure a better indicator of alveolar pressure than peak inspiratory pressure?
Because it reflects alveolar pressure at zero flow without the influence of airway resistance.

5. How is plateau pressure measured on a ventilator?
By performing an end-inspiratory pause to allow pressure equilibration.

6. What is transpulmonary pressure?
The difference between alveolar pressure and pleural pressure.

7. Why is transpulmonary pressure important in barotrauma?
It represents the true distending pressure of the lungs.

8. What is the difference between barotrauma and volutrauma?
Barotrauma relates to high pressure, while volutrauma results from excessive lung volume and overdistension.

9. What is ventilator-induced lung injury (VILI)?
Lung injury caused or worsened by mechanical ventilation.

10. What mechanisms contribute to ventilator-induced lung injury?
Barotrauma, volutrauma, atelectrauma, and biotrauma.

11. What is atelectrauma?
Injury caused by repeated opening and closing of alveoli.

12. What is biotrauma?
Inflammatory injury caused by mechanical ventilation.

13. What is driving pressure in mechanical ventilation?
The difference between plateau pressure and PEEP.

14. How is driving pressure calculated?
Driving pressure equals plateau pressure minus total PEEP.

15. Why is driving pressure clinically important?
Higher values are associated with increased mortality in ARDS.

16. What is a common target for driving pressure in lung-protective ventilation?
Less than or equal to 15 cm H₂O when feasible.

17. What ventilator factors increase the risk of barotrauma?
High plateau pressure, high PEEP, and dynamic hyperinflation.

18. What tidal volume is recommended for lung-protective ventilation in ARDS?
Approximately 4 to 8 mL/kg of predicted body weight.

19. What is a common target tidal volume in ARDS management?
Around 6 mL/kg of predicted body weight.

20. What plateau pressure target helps reduce barotrauma risk?
Less than or equal to 30 cm H₂O.

21. What should be done if plateau pressure exceeds 30 cm H₂O?
Reduce tidal volume to lower alveolar pressure.

22. What is permissive hypercapnia?
Allowing elevated carbon dioxide levels to protect the lungs from excessive ventilation pressures.

23. How is predicted body weight calculated for ventilator settings?
Based on patient height using standard formulas.

24. What is the role of PEEP in lung-protective ventilation?
To prevent alveolar collapse and improve oxygenation.

25. How can excessive PEEP contribute to barotrauma?
By increasing lung distending pressure and causing overdistension.

26. In which patients is higher PEEP often considered?
Those with moderate to severe ARDS.

27. What is auto-PEEP?
Unintended positive pressure due to incomplete exhalation.

28. Why does auto-PEEP increase the risk of barotrauma?
It causes air trapping and increased lung distending pressure.

29. What ventilator adjustments can reduce auto-PEEP?
Increasing expiratory time and reducing respiratory rate.

30. What does an increase in peak pressure with stable plateau pressure indicate?
Increased airway resistance rather than decreased lung compliance.

31. What does new subcutaneous emphysema in a ventilated patient suggest?
It suggests an air leak syndrome such as barotrauma or airway injury.

32. What serious complication must be ruled out when subcutaneous emphysema is detected?
Pneumothorax, including tension pneumothorax.

33. Which patient populations are at increased risk for pulmonary barotrauma during mechanical ventilation?
Patients with ARDS and those with chronic lung diseases such as emphysema, asthma, or interstitial lung disease.

34. What pathophysiologic process is a major cause of barotrauma in patients with airflow obstruction?
Dynamic hyperinflation

35. What is dynamic hyperinflation?
Air trapping that leads to intrinsic PEEP and increased lung volumes.

36. What ventilator-related factors contribute to dynamic hyperinflation?
High respiratory rate, inadequate expiratory time, and excessive tidal volume.

37. What are key determinants of dynamic hyperinflation that clinicians can influence?
Tidal volume, respiratory rate, and intrinsic PEEP.

38. What is the immediate life-saving treatment for tension pneumothorax?
Emergency decompression followed by chest tube placement.

39. What is the first step in managing suspected tension pneumothorax?
Immediate needle or finger decompression.

40. What is the definitive treatment after initial decompression of a tension pneumothorax?
Tube thoracostomy

41. What are priority actions for a respiratory therapist when tension pneumothorax is suspected?
Notify the team, provide oxygen, assess the patient, and assist with decompression.

42. How are pneumothoraces typically managed in ventilated ICU patients?
With chest tube placement rather than observation.

43. What type of chest tube is often used as first-line treatment for pneumothorax?
Small-bore chest tubes.

44. What is the standard drainage system used for pneumothorax management?
An underwater seal chest drainage system.

45. When is suction added to a chest tube system?
If the lung does not re-expand or an air leak persists.

46. What defines a persistent air leak?
An air leak lasting more than 5 to 7 days.

47. What ventilator strategy is used to manage persistent air leaks?
Reducing airway pressures and tidal volume.

48. Why is reducing ventilator pressure important in persistent air leaks?
To minimize airflow through the fistula and allow healing.

49. When should thoracic surgery consultation be considered for an air leak?
If the leak persists beyond several days or worsens.

50. What ventilator parameters should be monitored to reduce lung injury risk?
Tidal volume, plateau pressure, PEEP, and driving pressure.

51. How often should plateau pressure be assessed in lung-protective ventilation?
At least every 4 hours and after ventilator adjustments.

52. What inspiratory pause duration is used to measure plateau pressure?
Approximately 0.5 seconds.

53. What is the “baby lung” concept in ARDS?
Only a small portion of the lung is available for ventilation.

54. Why is the “baby lung” concept important for barotrauma prevention?
Because normal tidal volumes can overdistend the remaining functional lung.

55. Why can airway pressure alone be misleading when assessing barotrauma risk?
Because it does not account for pleural pressure or true lung stress.

56. What is transpulmonary pressure a better indicator of?
Actual lung distending pressure.

57. How can spontaneous breathing increase barotrauma risk?
Strong inspiratory effort increases transpulmonary pressure.

58. What is patient self-inflicted lung injury (P-SILI)?
Lung injury caused by excessive patient effort during breathing.

59. What are key mechanisms of P-SILI?
Overdistension, uneven lung inflation, and increased pulmonary edema.

60. Why is controlling patient effort important in ventilated patients?
To reduce lung stress and prevent further injury.

61. What are examples of high-risk features in pneumothorax that require urgent intervention?
Hemodynamic instability, significant hypoxemia, bilateral pneumothorax, underlying lung disease, and hemopneumothorax.

62. What is the standard treatment for a symptomatic primary spontaneous pneumothorax?
Needle aspiration or chest tube placement with an underwater seal system.

63. How is ventilator-associated lung injury (VALI) different from ventilator-induced lung injury (VILI)?
VALI is a broad term, while VILI refers to specific mechanisms such as overdistension and inflammation.

64. What ventilator-related process causes shear stress injury in the lungs?
Repeated opening and closing of alveoli.

65. How does properly applied PEEP reduce lung injury?
By preventing alveolar collapse at end-expiration.

66. Why is zero PEEP generally avoided in ARDS patients?
It promotes alveolar collapse and increases lung injury risk.

67. How do ventilator alarm limits help prevent barotrauma?
They provide early warnings for unsafe pressures or volumes.

68. What is the purpose of a high-pressure alarm in mechanical ventilation?
To stop inspiration if airway pressure exceeds a safe limit.

69. When might a clinician consider switching to a pressure-targeted mode?
When plateau or peak pressures become excessively high.

70. Why can pressure-controlled ventilation still cause lung injury?
Tidal volumes may become excessive if compliance improves or patient effort increases.

71. Why can airway pressures rise even if tidal volume remains constant?
Due to increased airway resistance or decreased lung compliance.

72. What pressure pattern is typical in severe asthma during ventilation?
High peak pressure with relatively normal plateau pressure.

73. What does a normal plateau pressure with high peak pressure suggest?
Increased airway resistance.

74. What is the typical tidal volume range for lung-protective ventilation?
Approximately 4 to 8 mL/kg predicted body weight.

75. How can driving pressure be reduced when PEEP is unchanged?
By lowering tidal volume or plateau pressure.

76. What happens to driving pressure if PEEP increases while plateau pressure stays the same?
Driving pressure decreases.

77. Can barotrauma occur even when ventilator pressures appear normal?
Yes, especially in vulnerable lung tissue.

78. What is a pneumothorax?
Air accumulation in the pleural space.

79. What is pneumomediastinum?
Air accumulation in the mediastinum.

80. What is pneumopericardium?
Air within the pericardial sac.

81. What is pneumoperitoneum in the context of barotrauma?
Air within the abdominal cavity from air leak syndromes.

82. How is PEEP typically adjusted in ARDS patients?
Higher PEEP for moderate to severe ARDS and lower PEEP for mild cases.

83. What do guidelines recommend regarding routine use of high-frequency oscillatory ventilation (HFOV)?
It is not recommended for routine use in ARDS.

84. What is the role of recruitment maneuvers in ARDS?
They may be used selectively with caution.

85. How long should clinicians wait between PEEP adjustments?
Approximately 5 minutes for initial assessment.

86. Why is an I:E ratio less than 1:1 commonly used in obstructive lung disease?
To allow adequate exhalation and reduce air trapping.

87. What should be done if auto-PEEP is detected?
Adjust ventilator settings to reduce air trapping.

88. What is the primary strategy to prevent barotrauma in ventilated patients?
Lung-protective ventilation.

89. What are two common causes of pneumothorax in ICU patients?
Barotrauma and iatrogenic injury.

90. What clinical signs may suggest pneumothorax in ventilated patients?
Hypoxemia, hypotension, tachycardia, and decreased breath sounds.

91. In a hemodynamically unstable patient with suspected tension pneumothorax, what intervention should not be delayed for imaging?
Immediate decompression followed by chest tube placement.

92. What adjunct therapy in early severe ARDS has been associated with reduced pneumothorax risk in some studies?
Early use of neuromuscular blockade.

93. What term describes internal distending forces within the lung?
Lung stress.

94. What bedside measurement represents lung stress?
Transpulmonary pressure.

95. What is lung strain in the context of mechanical ventilation?
The change in lung volume relative to its resting size.

96. How does lung strain relate to volutrauma risk?
Excessive strain increases the risk of alveolar overdistension and injury.

97. Why does lung inhomogeneity in ARDS increase the risk of ventilator-induced lung injury?
Uneven distribution of ventilation causes localized overdistension and shear stress.

98. What ICU procedures are commonly associated with iatrogenic pneumothorax?
Thoracentesis, central line placement, and bronchoscopy with biopsy.

99. What imaging modality is most commonly used to diagnose pneumothorax in the ICU?
Portable chest X-ray.

100. What is the defining mechanism of a tension pneumothorax?
A one-way valve effect that traps air in the pleural space, increasing intrathoracic pressure.

Final Thoughts

Barotrauma is a serious complication of mechanical ventilation that results from excessive pressure within the lungs. It leads to alveolar rupture and the development of air leak syndromes such as pneumothorax and pneumomediastinum. The risk is highest in patients with reduced lung compliance or those receiving high ventilatory pressures.

Prevention remains the most effective strategy and involves the use of lung-protective ventilation, careful monitoring, and individualized care. Early recognition and prompt intervention are essential to minimize complications and improve patient outcomes in the clinical setting.